The overloaded Spanish public health system requires solutions to alleviate the stress brought on by an aging population and budgetary cuts. One such solution is the Receta Médica Electrónica (Electronic Medical Prescription) project that started in 2004 and will be implemented across all autonomous regions by the end of 2015 (see 'Description of the way to implement the initiative' and 'Lessons learnt' below).
The Electronic Medical Prescription solves several problems that have plagued the traditional paper-based system. It avoids doctors' and pharmacists' errors when transcribing or decoding names or dosages of drugs; it saves time and visits to the surgery for patients with chronic conditions and for their doctors, since with the new system doctors can prescribe drugs for up to a year in advance; it also helps to develop programs that promote the rational use of medicines, allowing doctors to prescribe in batches so that patients can obtain the drugs gradually over the course of their treatment.
As prescriptions are recorded by the Health Service of each autonomous region and shared with the Pharmacists Association and the Ministerio de Sanidad, Servicios Sociales e Igualdad (Ministry of Health, Social Services and Equality), it enables the use of this data for statistics and research within the Health Service, which can help design policies to adapt the Health Service to users' needs.
Policy Context
The Electronic Prescription program was introduced in Law 16/2003, which covers the cohesion and quality of the Spanish National Health Service. The law lays out the rules for the development of a national electronic network and its features, including the framework for the electronic prescription, for the Spanish public healthcare service and the guidelines for the collaboration with pharmacists.
The Royal Decree 1718/2010 further expands the prior law and lays out the rules that will guarantee doctor-patient confidentiality and avoid abuse of the system.
Description of target users and groups
The main targets are private citizens using the public Health Service, doctors and pharmacists. Secondary users are the regional governments and the Spanish National Health Service, which can cull data from the system to optimise and improve the regional and overall health services.
Description of the way to implement the initiative
The implementation of the project has been especially complex, as the Ministry of Health delegated the Health Service to each autonomous region in 1986. Since each regional Health Service is independent, the rate of deployment of the Electronic Prescription has been at the discretion of each regional government. In fact, although some regions were fast to adopt the system, such as Andalucía, which has been using Electronic Prescriptions for over a decade, other regions are just getting round to completing the deployment.
Another hurdle is that each autonomous region has developed its own electronic health network and distributed electronic cards with chips or magnetic bands, depending on the region, which are incompatible with those elsewhere. The Ministry of Health solved this problem by issuing a universal, statewide card in 2013, which is compatible across regions. The problem will be definitely solved with the issue of new national IDs to all Spanish nationals over 14 years old: the new-generation electronic identity cards, which were first issued in mid-2015, incorporate identity card, driving licence and National Health card.
There was also the problem of adapting the pre-existing information technology (IT) framework in each region in order to be compatible with each other and with the central hub run by the National Health Service.
The implementation of the Electronic Prescription also affects pharmacies as they need to update their software in order to be able to exchange data with the central hub, the regional Health Service database and their own association.
Although the Ministry of Health calculates savings would be up to EUR 300 million in the long run, each autonomous region has had to foot the bill of adapting to the new system. In Andalucía, the cost of converting to the system has been estimated at EUR 12 million, Madrid estimates the cost at EUR 2 million and in La Rioja, the new system would cost about EUR 239 000.
A report published by Farma Industria in April 2011 shows the disparities in how the implementation has been carried out.
Fortunately, most autonomous regions are now fully covered or will be shortly.
Technology solution
The Electronic Prescription is aimed at optimising patient-doctor face time and eliminating possible clerical and human errors from the process of prescribing and obtaining medicines. It is also designed to facilitate the collection of data for the autonomous regions and the National Health Service. This data will help plan policies to make the Health Service more efficient and better suited to citizens' needs.
The system relies on the patient's electronic health card and the link of the card to his/her medical record on several databases. When the doctor prescribes drugs to the patient he/she does so by selecting them from a database of available drugs. This reduces the chance of making a mistake and also gives the doctor the chance to choose a cheaper, generic version of the drug, which will save both the patient and the Health Service money. The prescribed drugs are linked to the card and stored on the Health Service database.
The doctor can prescribe up to a year's worth of drugs in advance for patients with chronic conditions, which is more convenient for the patient, who doesn't then have to visit the doctor each time a new supply is needed; it also makes the primary Health Service more efficient.
When the patient visits the pharmacy to purchase the drugs, the pharmacist swipes the patient's card, thus accessing the name and dosage of the drug for the patient.
The prescription is also recorded long-term on the patient's medical record, for statistical and research reasons, in the Pharmacists Association's and in the Regional and National Health Services' databases.
Main results, benefits and impacts
The biggest beneficiaries of the electronic prescription, as mentioned above, have been chronic patients and their doctors. The electronic prescription has increased the safety of those who regularly need to consume several types of medication and has reduced the number of doctor visits by up to 20 % in regions where the electronic prescription has been fully deployed.
In Andalucía, for example, one of the first regions to implement the Electronic Prescription, the solution has contributed towards reducing the number of visits by 15 % in primary healthcare; in other words, saving the service over 52 million visits. This in turn has contributed towards reduced waiting time and increased the overall time doctors can dedicate to each patient.
Return on investment
Return on investment: Not applicable / Not availableLessons learnt
The Electronic Prescription, if universally applied and made compulsory, could violate Spain and the European Union's privacy laws if a patient wanted to keep their data private. To solve this problem, users can opt out and require a traditional prescription that will not be shared with third parties, thus guaranteeing doctor/patient confidentiality.
In Spain, as mentioned above, responsibilities for the administration of the public Health Service are delegated to each autonomous region. This has proven a problem for the adoption of the electronic prescription nationwide since each region has adopted the system at their own pace. The goal of enabling patients to obtain their medication from any pharmacy in the country, even outside their home region, has not yet been reached.
Andalucía, for example, started to implement the system more than ten years ago and now every day clinic, hospital and pharmacy offer the service.
Murcia on the other hand did not start implementing the system until 2013; and in Castilla-León the pilot did not start until November 2014, so it is still in its testing stage. However, both regions expect to reach 100 % coverage by the end of 2015.
Scope: National